Optimal Treatment of Stage III Colon Cancer: What is the Big IDEA? - - PowerPoint PPT Presentation

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optimal treatment of stage iii colon cancer what is the

Optimal Treatment of Stage III Colon Cancer: What is the Big IDEA? - - PowerPoint PPT Presentation

Apr 12, 2023 191 likes •410 views

Optimal Treatment of Stage III Colon Cancer: What is the Big IDEA? Benjamin A. Weinberg, M.D. Assistant Professor of Medicine Lombardi Comprehensive Cancer Center Georgetown University The Old Standard: All eligible patients should

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Optimal Treatment of Stage III Colon Cancer: What is the Big IDEA?

Benjamin A. Weinberg, M.D. Assistant Professor of Medicine Lombardi Comprehensive Cancer Center Georgetown University

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The Old Standard:

All eligible patients should receive 6 months
f FOLFOX or CAPOX for stage III disease

André et al. J Clin Oncol 2015.

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André et al. J Clin Oncol 2015.

MOSAIC Trial: N1 vs. N2 Disease

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Stage III Colorectal Cancer

50% cured by surgery alone 25% cured by surgery + chemo 25% not cured by surgery or chemo

50% 25% 25%

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Stage III Colorectal Cancer

50% cured by surgery alone 25% cured by surgery + chemo 25% not cured by surgery or chemo

50% 25% 25%

5% cured by addition of

xaliplatin

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Does Everyone Really Need 6 Months?

Grothey et al. N Engl J Med 2018.

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IDEA Collaboration

Grothey et al. N Engl J Med 2018.

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IDEA Collaboration

Grothey et al. N Engl J Med 2018.

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IDEA Collaboration

Grothey et al. N Engl J Med 2018.

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Grothey et al. N Engl J Med 2018.

IDEA Collaboration

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Sobrero et al. ESMO GI 2019.

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Can We Be Smarter?

Treatment selection based on 19th century

technology (sorry pathologists…)

What about 20th-21st century technologies?

– Immunoscore: CD3+ and CD8+ T cells in the center and periphery of the tumor – Circulating tumor DNA

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Pagès et al. ASCO AM 2019.

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Pagès et al. ASCO AM 2019.

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Pagès et al. ASCO AM 2019.

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Pagès et al. ASCO AM 2019.

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ctDNA Detection Post-Op and After Completion of Adjuvant Chemo Predicts for Recurrence in Stage III Colon Cancer

Presented By Jeanne Tie at 2019 Gastrointestinal Cancer Symposium

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Presented By Jeanne Tie at 2019 Gastrointestinal Cancer Symposium

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Conclusions – Stage III Colon Cancer

3 months of adjuvant FOLFOX/CAPOX is

technically not non-inferior to 6 months

But, 3 months can be preferred in T1-3N1

(low risk) stage III colon cancers with significant reduction in peripheral neuropathy

Immunoscore and ctDNA may inform

treatment selection in the future (trials underway)

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Questions?

baw12@gunet.georgetown.edu
@benweinbergmd